What Are the Symptoms and Complications of Hepatitis C?

Hepatitis C symptoms may include jaundice, a condition in which the eyes and skin become yellowed.

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Hepatitis C is an inflammation of the liver caused by the hepatitis C virus (HCV). Its symptoms can vary, depending on if the disease is acute or chronic, and it can lead to serious complications.

Hepatitis C can be transmitted to you if the blood of an infected person gets into your body, such as from sharing needles during intravenous drug use, being born to a mother infected with hepatitis C, or suffering an accidental needle injury.

Less commonly, a person can get HCV through sexual contact with someone who is infected.

It's unlikely that you could get hepatitis C from a blood transfusion today, since blood banks test all donated blood samples for hepatitis C.

In some cases, hepatitis C causes only a mild illness for less than six months before the virus passes out of the body. In other cases, however, it's a serious, lifelong illness that damages the liver. (1) Hepatitis C is sometimes classified by different stages of the disease: acute, chronic, and end stage.

"The majority of people with chronic hepatitis C are asymptomatic until the liver becomes severely damaged."

Acute Hepatitis C: What Are the Signs and Symptoms?

For acute hepatitis C, the incubation period (the time between infection and showing symptoms) is two weeks to six months after exposure, with an average time of six to seven weeks, according to the Centers for Disease Control and Prevention (CDC). (1)

Up to 80 percent of people who contract acute hepatitis C do not show any symptoms, the CDC notes. The other 20 percent of people with acute hepatitis C have the following symptoms:

For reasons that aren’t well understood, about 15 to 25 percent of people exposed to HCV develop only an acute infection, which clears from the body within six months. (2) The remaining 75 to 85 percent develop chronic hepatitis C.

Chronic Hepatitis C: What Are the Signs and Symptoms?

The majority of people with chronic hepatitis C are asymptomatic until the liver becomes severely damaged, often decades after exposure. In fact, it's common for people to unknowingly carry HCV until they go through a blood screening or other examination for reasons unrelated to hepatitis C. (2)

However, chronic hepatitis C is a serious issue that can result in long-term health problems, including liver damage, liver cancer, liver failure, and death.

According to the CDC, approximately 10 to 20 percent of people develop cirrhosis (an irreversible scarring of the liver that prevents the organ from functioning normally) over a period of two to three decades. (2)

People with cirrhosis have a 1 to 5 percent annual risk of developing liver cancer and a 3 to 6 percent risk of hepatic decompensation (the development of serious, life-threatening liver-related problems). There’s a 15 to 20 percent risk of death in the year following the development of decompensation. (2)

Age and gender have been shown to affect how chronic hepatitis C progresses. It doesn’t advance to cirrhosis and liver cancer as quickly in premenopausal women as it does in men, according to a report in Southern Medical Journal. (3)

Alcohol can accelerate the development of liver damage. The symptoms of chronic hepatitis C vary depending on the type of liver damage.

"Cirrhosis, or scarring of the liver, can lead to end-stage liver disease and liver failure."

What Are the Complications of HCV-Related Cirrhosis?

The scarring, which is irreversible, ultimately prevents the liver from functioning properly. A common complication of liver scarring is portal hypertension, in which there's an increase in pressure in the portal vein that carries blood between the digestive organs and liver. (5)

Portal hypertension can cause various other issues:

Ascites (a buildup of fluid in the abdomen that results in abdominal bloating)

Varices (enlarged blood vessels) in the esophagus and stomach, which can lead to gastrointestinal bleeding

Cirrhosis can eventually lead to end-stage liver disease and liver failure, which is accompanied by several debilitating symptoms, including hepatic encephalopathy (a buildup of toxins in the brain that can result in decreased mental function, stupor, and coma). (6)

Hepatitis C and the Risk for Liver Cancer

Liver cancer, which generally develops after a person already has cirrhosis, can result in jaundice, easy bruising and bleeding, a swollen abdomen, and abdominal pain or tenderness.

Hepatocellular carcinoma (HCC) is the most common type of liver cancer, and reports estimate that about 1 to 8 percent of people with HCV-related cirrhosis develop HCC annually. (7,8)

Liver cancer can also develop without cirrhosis, though it is less common. (9)

The symptoms of liver cancer are similar to those of cirrhosis but also include pain in the upper right abdomen or just below the right shoulder blade, and abnormal or easy bruising. (10)

Symptoms of End-Stage Hepatitis C

If chronic hepatitis C is not treated, it can progress to end-stage hepatitis C, or HCV-induced end-stage liver disease, which can be fatal.

According to the latest data available from the CDC, hepatitis C was responsible for more than 18,000 deaths in the United States in 2016; however, the CDC notes that figure is only a fraction of the deaths thought to be attributable in whole or in part to hepatitis C. (11)

End-stage liver disease is accompanied by many debilitating symptoms: (12)

Extreme fatigue

Severe itching of the skin (pruritus)

Abdominal swelling

Hemorrhaging and enlargement of the veins, which can cause gastrointestinal bleeding

Cognitive decline from the accumulation of toxins in the bloodstream, which can result in mild cognitive impairments (problems with thought processes), severe loss of brain functions, and coma

Because hepatitis C is often undiagnosed for years until serious, sometimes irreversible symptoms arise, it’s highly important to get screened for the virus if you’re at risk.

Additional reporting by Deborah Shapiro

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